Abstract

Introduction - ‘Sisters with a Voice’, Zimbabwe’s nationally-scaled comprehensive program for female sex workers (FSWs), intensified community mobilisation activities in three sites to increase protective behaviors and utilization of clinical services. We compare indicators among FSWs at the beginning and after implementation. Methods – We used mixed methods to collect data at three sites: in-depth interviews (n=22) in 2015, routine clinical data from 2010 to 2015, and two respondent driven sampling surveys in 2011 and 2015, in which participants completed an interviewer-administered questionnaire and provided a finger prick blood sample for HIV antibody testing. Estimates were weighted using RDS-1 and estimate convergence assessed in both years. We assessed differences in six indicators between 2011 and 2015 using logistic regression adjusted for age, duration in sex work and education.Results - 870 FSWs were recruited from the three sites in 2011 and 915 in 2015. Using logistic regression to adjust for socio-demographic differences, we found differences in the estimates of the proportion of HIV positive FSWs and HIV positive FSWs who knew their status and reported being on ART in Mutare and Victoria Fallsbetween 2011 and 2015. Reported condom use with clients was similar at both time points; however, condom use with regular partners different in 2015 in Mutare and Hwange. Reported HIV testing in the last 6 months among HIV negative FSWs was different at all sites for instance in Victoria Falls it was 13.4% (95% CI 8.7 – 19.9%) in 2011 and 80.8% (95% CI 74.0-87.7) in 2015. FSWs described positive perceptions of the Sisters program, ease of engaging with health services, and improved solidarity among peers. Program data showed increases in services use by 2015 across all sites. Conclusion – Improvements in key HIV care engagement indicators were observed among FSWs in two sites and in testing and prevention indicators across the three sites after implementation of an intensified community mobilisation intervention. Engagement with services for FSWs is critical for countries to reach 90.90.90 targets.